Background: Diagnostic and operative hysteroscopy are standard procedures in gynecologic practice. Complication rates are low, but serious events may occur. Case: A case with a life-threatening complication that has not previously been described, is reported. A 48-year-old woman treated for menorrhagia with endometrial resection is presented. During the procedure a perforation was identified with an injury to the right internal iliac artery. The patient required prolonged cardiopulmonary resuscitation (CPR), a massive blood transfusion, vascular surgery, and a hysterectomy. Results: This patient recovered well after a period in the intensive care unit. A review of the literature on risk factors for the occurrence of life-threatening hysteroscopic complications and the possibilities to avoid these, is included. Conclusions: The recognition of complications and prompt intervention reduces adverse outcomes. Hysteroscopic procedures are not free from serious complications or mortality, and should therefore only be performed if there is an appropriate indication and availability of equipment and assistance to treat possible complications. (J GYNECOL SURG 27:179)
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